Any advice on Bcbs denials

My insurance denied me for the sleeve but approved to remove the band. My doctor did a peer to peer and still denied. They didnt know if I was complicate(on both denials). I switched doctors about a year or so after my banding. He was to far and I never got any restriction. My second dr was awesome but we moved to Texas and didn't need any fills because I had restriction. Last year i start getting bad reflux. I went to this new doctor & he sent me for upper GI. I did the psych & nutrition evaluation. So my doctor sent in an appeal to get in approved. They didnt include my progress notes from my first dr. Im hoping the approve it because I cant take it.

Mine is a revision from gastric bypass to gastric sleeve as my bypass is over 10years old and not working well. I have a hiatal hernia too and was driven to very negative thoughts about insurance and myself when received first and second denial for all by BCBS FEDERAL EMPLOYEES PLAN, but on third appeal I wrote a clear and compelling letter to be reviewed with my third appeal and after another two months they approved it all!! I'm so grateful my Dr office finally recommended I tell them why I need the surgery and I don't know if that's why they reversed their denial to an approval but I'm very lucky and now very scared too as my surgery#1 is June 1 and I start the two week cleansing and liver shrinkage diet in 1week.

Good luck and respond if you want.

Karenytrevision

Congats! My doctprs office said this was my last appeal & I couldn't apeal again. Im so lost!

Congratulations on getting approved. I too am having problems getting approved for a revision. Do you mind if I ask what you said in the letter you sent them? I'm curious as to what would change their minds. Thanks you

Karen,

Do you mind sharing the letter you sent to them with me? You can remove any info you feels you don't want to share. I will need to harp my insurance too!

You can email it to me privately at [email protected].

Thank you,

Julie

Do you know if the BCBS that you have has a one in a life time clause for WLS?

No they had no clause. Maybe i should erite a letter but the submitted it already.

Call your BCBS office and talk to your case manager. Find out exactly why they denied you and see if you can talk to them.

Surprising. The people in my Dr.'s office kept telling BCBS is one of the easiest to get approval. I got a approved with just script from my primary care doctor just wrote "Mark would benefit from weight loss surgery." Go figure. I still had to do all the tests though.

My BCBS is FEP federal employees and I was threatened with the last appeal but if your Dr is seeking the insurance claim you still have your rights too which they don't tell you about. This is according to an insurance attorney my doctor referred me to after second denial.

Karen